The Journal of urology | 2019
Fosfomycin Trometamol versus Comparator Antibiotics for the Treatment of Acute Uncomplicated Urinary Tract Infections in Women: A Systematic Review and Meta-Analysis.
Abstract
PURPOSE\nTo perform a systematic review and meta-analysis to compare the effectiveness and safety profile of fosfomycin versus comparator antibiotics in patients with acute uncomplicated cystitis in adult women.\n\n\nMATERIALS AND METHODS\nRelevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Assessment of risk-of-bias and confounders was performed. The primary endpoint was the clinical or microbiological success, defined as the complete (cure) and/or non-complete resolution of symptoms at the end of treatment (improvement) and/or microbiological eradication.\n\n\nRESULTS\nAfter screening 539 articles, 15 studies were included recruiting a total of 2,295 adult female patients. Fourteen studies were used for microbiological eradication analysis while 11 out of 15 were used for clinical resolution (1,976 patients). Eleven studies were used for safety outcome analysis (1,816 patients). No difference was found regarding all comparators combined [11 RCTs, 1,976 patients, odds ratio (RR) 1.16; 95% confidence interval (CI) 0.91-1.49; p=0.13] in terms of clinical resolution. No difference was found for microbiological eradication [14 RCTs, 2,052 patients, OR: 1.03; 95% CI: 0.83-1.30; p=0.09] or for safety outcome [11 RCTs, 1,816 patients, OR: 1.17; 95% CI: 0.86-1.58; p=0.33]. Most adverse effects reported for fosfomycin were transient and single-dose therapy seems to give a better patient compliance.\n\n\nCONCLUSIONS\nSingle-dose oral fosfomycin trometamol is equal to comparator regimens in terms of clinical and microbiological effectiveness and safety in adult women with microbiologically confirmed and/or clinically suspected acute uncomplicated cystitis and is associated with a high patient compliance.